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The campaign, Eyes Tell the Story: The Impact of Dry Eye, will work to educate the public about dry eye by means of personal stories and survey data.

Bausch + Lomb's new dry eye survey data ushers in campaign for patient education

In this podcast, experts Quan Dong Nguyen, MD, MSc; and Cecelia Koetting, OD, FAAO, DipABO; discuss the diagnosis, staging, and treatment of NK, focusing on early-stage disease.

Neurotrophic Keratitis: Multidisciplinary Approaches to Enhance Patient Outcomes

In this podcast, experts Deborah Ristvedt, DO; and Melissa Tawa, OD, FAAO, discuss individualizing glaucoma therapy with selective laser trabeculoplasty and sustained-release drug implants, providing key take-home insights for optimizing glaucoma management across diverse patient profiles.

Navigating the Glaucoma Therapeutic and Surgical Landscape from Conventional to Cutting Edge

In addition to Prevent Blindness’s usual free resources, the organization is providing a dedicated webpage, fact sheets, and graphics in both English and Spanish.

Prevent Blindness declares July to be Dry Eye Month, provides patient resources

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Clinical Focus

A decision by the FDA is expected in August 2022. 

Apellis submits NDA to FDA for geographic atrophy treatment

A look at the latest developments in retinal disease, including clinical trials and advanced therapies.

What’s hot (and not) in retinal news

New detailed, longer-term findings were presented at the 2022 ARVO meeting.

Apellis releases 18-month results from phase 3 studies of pegcetacoplan for GA 

This podcast provides a review of some of the key highlights from the Controversies in Modern Eye Care meeting held in April 2023. The program is designed for those who did not attend the live meeting and to help reinforce learnings for those who did.



 This transcript has been lightly edited for clarity.

At the present time, we really have no idea of what causes geographic atrophy, but a lot of attentions being played to the alternative pathway in the complement cascade, as everybody knows, there's three complement pathways. There's the classical, the lectin, and the alternative pathways. There is evidence drusen and in other histopath pathologies that there are complement factors that are involved in drusen, also in the pigment epithelium. There are certain complement changes that will potentially cause these changes to progress. So a lot of attention is being played in the alternative pathway. There is one drug, Annexon, that's being used in the classical pathway. It has some rationale because it's down-regulating C3, but from a different angle. C3 unfortunately, or fortunately, I guess, is the commonality of all three of the pathways, the alternative, classical, lectin pathway. But there is some evidence that C1q, which is found in the classical pathway, will have a role. It does play a role in synapses. It's also found on drusen.

Most of the work is being done in trying to reduce the alternative pathway from even starting. So down-regulation of the alternative pathway is the goal from almost all these drugs. If you start the alternative pathway and it goes through from C3 to C5, all the way to C9, you get what they call apoptosis. So the little cells at the edge of your atrophy begin to have holes, pores put into them, and the cells die. So by treating and trying to reduce the progression, we're hopefully going to reduce the apoptosis that occurs as the final event. So there are many different factors that are being looked at. We have factor I, factor B, factor D, all which down-regulate the complement system. Factor D happens to be a oral medication very similar to lampalizumab, which failed. We have factor I, which is a gene therapy that also down-regulates the system.

Factor B down-regulates the system. Well, there's also the ability to put in complement factor H that may be not present and some patients, and if they can do that, may slow it down. There's a new company that just started. There are some good factors that stop neovascularization from occurring on a genetic basis and they're being placed into the eye and hopefully can reduce progression. But the two major areas are inhibition of factor C3 and C5. C3 is a drug known by Apellis. This drug has been approved by the FDA and showed a fairly significant improvement in the extrafoveal geographic lesions. The extrafoveal lesions basically grow faster and they grow faster, and by reducing them, you can hopefully stop the lesions from growing into the center of the fovea and losing vision.

In fact, in their study, they showed about 27% reduction in these extrafoveal lesion growths, and they recently, just a few weeks ago at ARVO presented that if patients are 250 microns or greater from the center of the fovea, that those patients at two years had five letter better vision than they did in the group that was in the sham group that wasn't treated.

They also have shown that the lesions by visual field tend to not grow as much and you save off more retina. Lesions that are sub-foveal tend to grow at a slower rate in general, and it's only about a 16-18% reduction in the growth rate in that. There's no free lunch in medicine. There's always safety, which is the biggest concern that we have. We've had very excellent drugs recently for treating AMD, but because of the side effect profile and the safety, have never really been utilized to any great degree. The safety is good, but there was about 8% of patients that did go on to developing wet macular degeneration. Inflammation was about 1.5%. There's a small incidence of infection, but that goes along with almost every drug you put into the eye. The C5 is the next drug that will probably be approved.

It is basically, I think in July or August is their PDUFA date. So we'll know in July or August if the approval comes forward. But they should be approved. They have had two phase three trials that both showed statistically significant improvement, whereas in the Apellis drug, it took the C3 inhibitor, it did take 18 months before they started to show an improvement in one of the trials. And at 24 months, both trials were clinically and statistically significant. C5 is downstream from C3 and again, blocking it will decrease the ability for C5b to go on to activating the MAC complex at C9. Another drug that's being tested right now is CD59. It's a drug that actually, CD59 is a natural occurring protein that is in the eye. It goes up when you have AMD and if you can down-regulate that... I'm sorry, it goes down when you have goes down when you have wet AMD, and if you raise that, it will be a natural inhibitor of the progression.

It's a gene therapy. So one and done. Also has been shown to reduce progression of geographic atrophy, again, by the fact that it stops the progression to the MAC complex, it doesn't allow it to form, but we have a lot of unanswered questions. What starts the complement pathway? Is it amyloid? Because amyloid is found in drusen? Is that what stimulates and causes the pathway to begin? Do we have to treat forever? Can we treat just acutely and stop the process? How long do we have to do it? Is it forever? Is this something that we have to do forever? Or once you get the patient righted and you're not having any further inflammation in that pathway, can you back off? And would combination therapy be a more benefit? You've got a C3 inhibitor and a C5 inhibitor both showing about 27% decrease in the extrafoveal lesions.

If you put them together, would that equal an improvement? If you added C3 to CD59, would that cause a bigger improvement? And those are things that'll have to be worked out in the future. Certainly, gene therapy or longer-acting delivery systems are going to be the answer to this. It's not very sustainable to give monthly or even every other month injections to these patients. And the other thing that I'm really amazed about is the number of patients who have dry AMD. When you look at autofluorescence or look at their OCTs or look at their photographs, have geographic atrophy present. It's a lot larger population than I originally thought.

So first, you can have direct damage, which is through the membrane attack complex, which directly targets the RPE cells, and you can also have the indirect damage, which is to the photoreceptor cells where you get that abnormal protein deposition, which directly leads to the mortality of photoreceptor cells.

Evidence supporting the contribution of the complement system to progression of AMD and GA has accelerated the development of therapeutics targeting complement protein C3 and C5. Drugs being investigated include avacincaptad pegol, which inhibits C5 and C5 cleavage, pegcetacoplan, which prevents C3 activation, ANX007, which inhibits C1q, and GEM 103, which controls the complement cascade. Let's listen to Dr. Boyer review these agents.

At the present time there are a number of companies that are investigating the complement pathway as a means of slowing down the progression of geographic atrophy. The thought being that the geographic atrophy occurs and progresses due to dysregulation of the complement system. We don't know what starts it. We don't know if it's started by amyloid, oxidative stress can start this, but there are a variety of different causes that activate the complement pathway. Why the complement pathway? Because a lot of complement factors that are being investigated are found within drusen, and drusen are a hallmark of dry macular degeneration. We also can see that complement factors that are involved in genetics also play a major role.

So if we go to the GATHER 1, 2 trial, which is a C5 inhibitor, basically at this time it's PDUFA date or the day that the FDA has to announce whether they'll allow us to use it or not or approve it is in late July, early August, and it probably will be approved because they've had two 12 month phase three trials that both showed an improvement. In this trial the patients had have to have extra fovea lesions, meaning that the area of geographic atrophy was not centered and was not under the center of the fovea. It could be one micron away, but that was considered non-central involvement. And in that case, in the first GATHER 1 trial, there were about a 27% reduction in progression. In the GATHER 2 trial, it was much more modest, about 16 to 18% reduction.

They were both statistically significant. And when you looked at the GATHER 1 trial data over a long period of time, 18 months, that held, and we don't have the long-term GATHER 2 data. In the second year of the GATHER 2 trial, 50% of the patients went to every other month, and some continued on a monthly basis. Now, there are other differences between the trials, but the safety of the C5 inhibitor was excellent. They had no signs of uveitis. They had a very small incidence of conversion to wet macular degeneration, about 6%.

They seem to have excellent response. They've showed a reduction in the three line loss of vision by patients being treated over the period of time. So we don't have that drug available yet, but at least for non subfoveal lesions, extrafoveal lesions, this appears to be a good alternative. The drug that has been approved recently is a C3 inhibitor by a company called Apellis. It's called SYFOVRE. And this drug acts within the complement system and is central to all the complement pathways. There are three complement pathways. There's the classical, the lectin, and the alternative, and they all meet at the C3 and then go on to C5. And the C3 blockage eliminates C3b from activating the alternative pathway and allowing it to not go to the MAC complex. They've done two trials, DERBY and OAKS. The OAKS trial was positive at 12 months showing an excellent reduction in vision.

The DERBY trial did not meet its primary specified endpoint, but at 18 months, both of them did, then at 24 months the results were excellent. For the extrafoveal lesions, which were about one third of all the lesions in their trial, they showed about a 27% reduction, very similar to the C5 inhibitor I just discussed. They also, however, had a very large percentage of patients who had the lesion under the foveal area, and those the results again, were positive compared to the sham and as well in growth. However, the growth rate was much less, in the range of about 16 17%. The growth rate was significantly decreased. In their trial again, the safety was good. There was slightly a higher incidence of inflammation, though the inflammation was mild and was treated with topical steroids. Also in addition to that, there was about an 8% risk of developing the wet MAC degeneration, having exudative form of Mac degeneration, that form.

There also had eight patients in the trial that went on to developing ischemic optic neuropathy, which seems to be a puzzle that nobody has been able to figure out. There was one patient, I think, in the GATHER trial, and there was one patient omalizumab, which was a very large trial. So this showed a definite change that's been investigated, and two neuro ophthalmologists that are world renowned could not find a correlation, and they found that all the patients had a disc at risk. They all had some other vascular episodes at a similar period of time, whether it be hypertensive crisis or some other change, and felt that this was based on that. But that is still something that needs to be discussed. There are several other complement factors that are being evaluated all again, to slow down the process of the alternative pathway. There's factor B, factor D, factor I.

There's patients who are receiving a CFH. There are also people that are now treating and trying to improve the genetics by giving proteins, or I'm sorry, giving the genes that are positive that actually can overcome the negative genes. There's one in the classical pathway called C1q that's being blocked that they feel is important. It plays a role in synapses and it's also found on drusen, so there is some reason to do it. By blocking it it does reduce C3 further down. Now, as you go down the complement pathway, you eventually end up at C9. And C9 is the MAC complex. It's composed of 5, 6, 7, 8, and 9, and it causes a pore formation, which causes cell to rupture and die. CD59 is a natural occurring protein that reduces the progression. It's found to be decreased in patients with macular degeneration.

And by gene therapy they can add CD59 as a protective mechanism. This protective mechanism may reduce the progression of the geographic atrophy and also reduce the progression of the wet MAC degeneration. So this also is being studied. There are a number of other drugs not in the complement pathway that are being studied to hopefully reduce the onset of the problem. One of them has to do with macrophages and trying to reduce the macrophages from becoming active and activating the complement pathway. Inflammasome are another substance that will cause the activation of the complement pathway and is being treated way upstream to hopefully stop the complement pathway from being activated. There are a number of other factors that are looked at. We know that our mitochondria go down as we get older, but in patients with macular degeneration, it goes down even more in the eye. So several companies are looking at treatment to try to improve the mitochondrial function over a period of time.

And as it improves the mitochondrial function, hopefully it will improve the low luminance vision, the poor vision that we get at night or just age related macular degeneration causes patients to have more difficulty with night vision. Reading needs more light. Driving at night is not very easy to do for patients with macular degeneration. So there are a number of other factors that are being evaluated to try to reduce the onset of the alternative pathway, and also to try to slow it down and hopefully in the near future, some combination of these will give us better results than we have today.

Visual loss associated with advanced GA affects many aspects of patients' lives. Daily functions like household chores become more challenging. Patients may engage in fewer social interactions and may be isolated from family and friends. Let's listen to Doctors Boyer and Macdonald discuss how GA affects patients' quality of life.

Geographic atrophy is an area of loss of the pigment as well as the photoreceptors that lie above them. So everywhere that you have an area of geographic atrophy, you actually have an area that's a blind spot or a scotoma. And obviously as a scotoma comes into the foveal area, patients lose the ability to read, drive, see people's faces clearly. Prior to that though, in both dry macular degeneration as well as wet macular degeneration, patients begin to have more difficulty with night vision. They have a lot more difficulty. They may come in to see you and they're 20/20, and the biggest complaint is, they can't read anymore. Doctor will say, well, you're 20/20. I gave you some reading spectacles, you should be able to read. The biggest problem is the loss of the ability to see. They need a lot more light and they have a hard time driving at night.

They don't feel comfortable driving at night. And even though their vision may be 20/20, their dark adaptation really suffers very early in the course of this condition and continues on. So it would be wonderful to have a drug that would improve that because that's the major complaint that I hear when I see the patients in the clinic. These patients come in and they've gotten the best spectacle correction possible, and sometimes they are 20/20, but still have bitter complaints about reading and everything.

I remember one patient specifically when I told them to buy a light that goes over their shoulder or to get a Kindle, and the patient with the light came back and said, I can read. I can read. It was like a miracle, just having more light and the Kindle has been a big boon. I think patients who want to read and try to read, the Kindle with back lighting is much better than a lot of the other machines that are out there to allow them to read. So I think that it really makes it very difficult for patients to drive and to see people's faces clearly. And again, depending on where the scotoma is, it can be devastating if it's in the center.

It affects it drastically. First, you can have direct decrease of vision. So the visual impairment can affect everything that would require detailed vision. So reading, self-care, detailed vision. And it can also affect contrast sensitivity, which is being able to see shades of gray. So looking at something that wasn't high contrast, very black on white, for instance, looking at facial features of somebody or expressions or navigating in dimmer illumination. So this can lead to a decrease in self-care and activities of daily living, which then can make somebody feel like they are more dependent on others, and that can directly lead to decreased social interaction for people. And decreased social interaction is obviously going to lead to an impact on mental health for these individuals. So it affects them very severely.

Low vision aids and vision rehabilitation services may be especially helpful for patients with GA. Among individuals with low vision, an estimated 90% have useful residual vision that could be optimized from rehabilitation services. Many patients are unaware that these low vision services are available. Doctors Boyer and Mac Donald outline these services.

I think one of the things that we as physicians and eyecare professionals in general, really don't pay enough attention to is the wonderful advances that have been made in low vision. It's very frustrating for me as a doctor for many, many, many years to not have a treatment available for these patients, many of which are very active and except for their dry macular degeneration, geographic atrophy, really want to do things that are in good health. They want to travel, they want to do whatever they can. Some of them are professors and they like to read and they want to continue reading. So I refer a fairly large number of patients to low vision specialists because there are a lot of devices out there, and there are more to come. There are a lot of devices, unfortunately are very expensive, but there'll be glasses that will magnify and will be able to help them read, be able to read to them if they can't read.

There are certain devices that can actually read to them. You can take your iPhone and blow it up also. Just if you were shopping and you couldn't read a label, didn't know how much something costs, you can take a picture on your iPhone and just blow it up and be able to see what the price is so you don't go expecting a $15 item and it's $150 item. So I think that that low vision specialists really help the patients a lot. They teach them little tricks. In the home what they can do, they teach them about navigation. You won't see very many of the patients come in with a white cane, even though they may be legally blind from macular degeneration. It just doesn't happen in my experience. So they have to be very careful when they're outside. My mother, as I indicated earlier in the conversation, had severe macular degeneration, and I took her to a wedding.

My wife was out of town. My sisters were going somewhere else, and I realized that just going down an escalator was difficult for her because she couldn't see where it started and where it ended. Going to the restroom, everybody's got fancy restrooms, little things that sometimes I have to look three times to make sure I'm going into the correct one because the little models that they have on the door are sometimes questionable when I look at them for a while. So I think that there's so many things that low vision can help, just extra lighting. When you go to read a menu, they'll be embarrassed to pull it out. But I send a lot of patients to get low vision, and I think the low vision devices in the very near future will improve greatly.

So when somebody has a vision loss, supplementing that by going to a low vision specialist, looking at what your vision is and how much magnification you need or filters or lighting to help somebody improve their quality of life and daily living tasks is important. A low vision doctor will look at various assistive technology devices or regular optical devices to assist somebody, and they may even do specific training for the patient and have adaptive strategies for them, as well as being able to coordinate with all the other eyecare professionals and other interdisciplinary professionals to help the patient navigate this condition.

This podcast provides a review of some of the key highlights from the Controversies in Modern Eye Care meeting held in April 2023. The program is designed for those who did not attend the live meeting and to help reinforce learnings for those who did.

Advances in treatment for geographic atrophy

A study reveals a genetic link between instant coffee consumption and increased risk of dry age-related macular degeneration, urging caution for high-risk individuals.

Genetic link found between instant coffee consumption and dry AMD

The LMDD Eye Health Scorecard specifically evaluated insurance coverage for treatments addressing GA, neovascular AMD, and thyroid eye disease.

New national scorecard exposes insurance coverage disparities for vision-threatening disease treatments

The results of an investigation into iRORA identified a wide spectrum of fundus autofluorescence patterns that corresponded with iRORA lesions and that those patterns were associated with conversion to cRORA over time. 

iRORA phenotypes characterized using fundus autofluorescence

Valeda met the primary end point in the US LIGHTSIDE III trial, improving the best corrected visual acuity in patients for 24 months of >5 letters or equivalent to 1 line improvement on the eye chart, according to the company.

LumiThera announces top-line results from LIGHTSITE IIIB extension trial assessing the Valeda Light Delivery System

Topline results from the MAGNIFY phase 2 clinical trial of oral zervimesine show 28.6% slower geographic atrophy lesion growth compared with placebo.

Oral zervimesine reduced GA lesion growth in phase 2 study from Cognition Therapeutics

Priya S. Vakharia, MD, and Deepak Sambhara, MD, FASRS, provide tips to ensure effective comanagement between retina specialists, optometrists, and ophthalmologists.

Tackling early detection of geographic atrophy with the power of referrals

With anticipated treatments emerging for geographic atrophy (GA), the landscape of managing and diagnosing the disease has already seen significant shifts. Studies

 have shown that early identification is vital to stopping the progression of GA, which can be aided by effective comanagement between retina specialists, optometrists, and ophthalmologists. Priya S. Vakharia, MD; and Deepak Sambhara, MD, FASRS, have identified the importance of successful referrals and gave their tips to ensure the early detection of GA for optometrists to take back to their practices.

"There still seems to be a disconnect, personally speaking, with the types of referrals that come in from an optometrist for geographic atrophy to an ophthalmologist," said Sambhara. "I think the risk factors that predispose patients to quicker progression is something that we should really highlight. So what do those risk factors look like? We know that non-subfoveal lesions grow quicker than subfoveal lesions, so that's something to pay attention to. 

"The other thing is, multifocality is another predictor of progression. We know that multifocal lesions grow quicker than unifocal lesions. There are certain multimodal imaging characteristics like perilesional hyper autofluorescence. So if an optometry clinic happens to have autofluorescence imaging, I do think it's a great tool. But to me, characterizing the actual lesion, because not all GA is created the same, and so to know who's more likely to progress than others, it gives me a better way to start that conversation with the patient who might be sent over."

"I think the thing that we are increasingly realizing is treating GA earlier, before it becomes visually significant, is actually way better," said Vakharia. "We know that the rates of progression for extrafoveal disease is higher than for foveal involvement, and to try to catch those patients earlier is helpful. So I think the biggest thing I would wish is that even if there's a patient with extrafoveal disease who may not be symptomatic, to get them in just to see us so we can talk about treatment options."

Regillo C, Nijm LM, Shechtman DL, et al. Considerations for the identification and management of geographic atrophy: Recommendations from an expert panel. 

. 2024;18:325–335. doi:10.2147/OPTH.S445755

Kaiser PK, Karpecki PM, Regillo CD, et al. Geographic atrophy management consensus (GA-MAC): a Delphi panel study on identification, diagnosis and treatment. 

 2023;8(1):e001395. doi:10.1136/bmjophth-2023-001395

Videos

Priya S. Vakharia, MD; and Deepak Sambhara, MD, FASRS, provide tips to ensure effective comanagement between retina specialists, optometrists, and ophthalmologists.

Tackling early detection of geographic atrophy with the power of referrals 

Rachelle Lin, OD, MS, FAAO, on collaborating more effectively on neovascular retinal cases

Collaborating more effectively on neovascular retinal cases

Retinal vascular occlusions, neovascular age-related macular degeneration (AMD), and diabetic macular edema (DME) represent some of the most challenging chronic eye conditions managed in partnership between optometrists and retinal specialists. At the recent Collaborative Care Symposium, Rachelle Lin, OD, MS, FAAO, highlighted how newer retinal therapies are addressing treatment gaps by offering extended dosing intervals without compromising efficacy—ultimately easing the burden on both patients and providers.

Many patients with retinal conditions face monthly intravitreal injections, leading to treatment fatigue and, in some cases, dropout. According to Lin, newer anti-VEGF agents and sustained-delivery therapies are reducing this burden. These innovations offer optometrists an opportunity to reengage patients who may have fallen off the treatment path.

“As optometrists, we play a key role in making timely referrals, not just at diagnosis but throughout the treatment journey,” Lin emphasized. “We can help ensure patients stay engaged with their care by educating them on new options and supporting them between ophthalmology visits.”

Optometrists are often the first point of contact for patients experiencing visual changes. Lin encouraged her colleagues to take an active role in educating patients about what to expect during treatment, especially as protocols evolve.

“We need to make sure our patients are informed, motivated, and understand the importance of follow-up,” she said. “If they’re uncomfortable with their treatment plan, we should prompt them to speak with their ophthalmologist about other options.”

A team-based approach to vision preservation

Lin works closely with retinal specialists, particularly in cases where patients also require low vision rehabilitation. She noted that many of her patients see both their ophthalmologist for disease management and her clinic for tools like magnifiers, updated prescriptions, and DMV evaluations.

“Retinal specialists are doing an amazing job with cutting-edge treatments,” she said. “But once patients reach a certain point, they need support in living with reduced vision. That’s where we step in.”

Lin concluded, “By learning together and working together, we can support patients through the entire spectrum of their care journey.”

At the Collaborative Care Symposium, Rachelle Lin, OD, MS, FAAO, highlighted how newer retinal therapies are addressing treatment gaps by offering extended dosing intervals without compromising efficacy—ultimately easing the burden on both patients and providers.

Dr Luke Lindsell discusses retinal therapy and geographic atrophy at Controversies in Modern Eye Care 2025

CIME 2025: Luke Lindsell, OD, MD, on bridging innovation and practical care in retinal disease

, Luke Lindsell, OD, MD, offered a compelling perspective on how evolving therapies for 

 and improved imaging tools are reshaping 

. Now practicing at the Cincinnati Eye Institute and teaching at the University of Cincinnati, Lindsell emphasized optimism and pragmatism in how eye care professionals can collaboratively manage retinal disease.

“Having any therapy at all for GA has been exciting,” Lindsell stated, referring to the current intravitreal treatments now in clinical use. But what excites him most are the developments on the horizon: at-home therapies, gene therapy, and devices like the Valeda Light Delivery System (LumiThera), which uses photobiomodulation and shows early promise in preventing GA altogether.

Gene therapy and the quest to reduce treatment burden

With patient fatigue around frequent injections being a persistent concern, Lindsell highlighted the growing excitement around gene therapy. Although still in clinical trials, early results suggest these treatments could significantly reduce the frequency—or even eliminate the need—for repeated injections. “It’s what patients ask all the time: ‘When will I be done?’” he said.

Lindsell recommends a proactive approach to imaging for optometrists. “Most of us have an [optical coherence tomography scanner], but don’t forget about autofluorescence,” he urged. Utilizing autofluorescence alongside near-infrared imaging or red-free photography can enhance detection of subtle GA changes, particularly at the fovea, where natural hypoautofluorescence can mask early signs.

Lindsell emphasized that optometrists should feel confident in managing early to moderate stages of retinal disease, including diabetic retinopathy and macular degeneration. “Be the leaders in early retinal care,” he said. Discussions around supplements, glycemic control, and lifestyle modifications are key components of this care phase. Referral should be considered when vision is threatened or novel therapies become appropriate.

Collaboration built on respect and transparency

Above all, Lindsell championed a respectful, comanaged approach to patient care. “This patient is not mine,” he stated, reinforcing that a specialist’s role is to complement—not replace—the referring optometrist’s care. He communicates this clearly to patients and colleagues, advocating for shared decision-making and continuous communication.

Finally, he reminded ODs to set realistic expectations. Not every referral will yield a treatment option, especially in advanced disease. However, patients often benefit emotionally from a second opinion and a clearer understanding of their condition.

Lindsell discusses promising retinal therapeutics, such as at-home therapies, gene therapy, and devices like the Valeda Light Delivery System (LumiThera), which uses photobiomodulation and shows early promise in preventing geographic atrophy altogether.

Conference

Dr Dilsher Dhoot speaks on retinal disease and emerging therapies at Controversies in Modern Eye Care 2025

Dilsher Dhoot, MD, FASRS, expresses excitement for emerging retinal therapies, improved comanagement

2025 Controversies in Modern Eye Care conference

, Dilsher Dhoot, MD, FASRS, of California Retina Consultants shared his forward-looking perspective on developments in 

 management, highlighting both recent breakthroughs and promising innovations on the horizon. The Controversies in Modern Eye Care meeting took place May 4, 2025, in Los Angeles, California.

“We’re in a golden era of retina,” Dhoot began, referencing a wave of recent FDA approvals and a pipeline rich with potential. He expressed particular enthusiasm about gene therapy and tyrosine kinase inhibitors, which offer new hope for patients needing longer treatment durability. These therapies, he noted, are "just around the corner" and could significantly extend treatment intervals compared with existing regimens.

The evolution in geographic atrophy management

. “We haven’t traditionally had therapy for GA, but now we do,” he noted, referring to the 2 FDA-approved treatments that have emerged in recent years. While these agents can slow atrophy progression, he emphasized that this is just the beginning.

“The pipeline will include more durable agents, and possibly more effective ones,” he said. He also stressed the growing role of artificial intelligence (AI) in identifying patients who may benefit most from current and future treatments. AI-driven imaging and biomarker identification are already showing promise in personalizing care and improving outcomes.

Optometry’s pivotal role in retinal health

Dhoot praised optometrists for their role in early detection and referral. “You do a great job identifying these patients,” he said, emphasizing that timely referral doesn’t signify imminent vision loss. “Being sent to retina is not a sentence to blindness.”

He encouraged optometrists to reassure patients about intravitreal injections, noting that they’re less daunting than they sound. “The eye is a very easy place to inject,” he said, and with current therapies, patients can retain—and sometimes even improve—vision.

Referral thresholds and collaborative care

Dhoot urged optometrists to consider a low threshold for referral, particularly when diagnostic uncertainty exists or interventions are available. “For myself, if I’m not sure, I refer,” he said. While conditions like intermediate age-related macular degeneration or mild nonproliferative diabetic retinopathy can sometimes be monitored, he stressed the importance of access to advanced imaging and clear communication between providers.

As the field of retina rapidly advances, collaboration between optometry and retina specialists will remain crucial in delivering optimal patient care.

Dilsher Dhoot, MD, FASRS, shares his forward-looking perspective on developments in retinal disease management, highlighting both recent breakthroughs and promising innovations on the horizon.

Pipeline

CIME 25: Dilsher Dhoot, MD, FASRS, excited about emerging retinal therapies

Dr Steven Ferrucci at Controversies in Modern Eyecare 2025

Emerging hope in retinal disease: New therapies for GA and beyond

2025 Controversies in Modern Eye Care meeting

, which took place May 4, in Los Angeles, California, Steven Ferrucci, OD, FAAO, chief of optometry at the Sepulveda VA Hospital in Los Angeles and professor at Marshall B. Ketchum University, shared his excitement about advancements in 

, in an interview. His insights are a powerful reminder that the therapeutic landscape is evolving rapidly, bringing new hope for patients once considered untreatable.

New FDA-approved therapies for geographic atrophy

Geographic atrophy, the advanced form of dry age-related macular degeneration (AMD), is now receiving long-awaited attention. According to Ferrucci, 2 medications approved by the US Food and Drug Administration (FDA) have demonstrated the ability to slow GA lesion progression over time. While the specific drugs were not named, this likely refers to pegcetacoplan (Syfovre; Apellis Pharmaceuticals) and avacincaptad pegol (Izervay; Astellas Pharma), both of which received FDA approval in 2023.

“GA is probably a little more common than we might think,” said Ferrucci. With over 1.5 million Americans affected—a number he suspects is underreported—these new therapies mark a significant shift in how optometrists can manage this chronic and previously untreatable condition.

As a retinal expert, Ferrucci discusses some emerging retinal therapies that excite him.

Geographic Atrophy

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